Some Like It Hot, Some Cold – Understanding When To Use Hot and Cold Therapy For Injury

It can really get confusing when one has a muscle strain, sprained ankle and other similar maladies and is told to use “cold therapy” and “heat therapy”. The mantras are “only use cold”, “use cold for first 24-48 hours”, “don’t use cold use warm moist heat to stop your pain”. How is one to know what to do?

Often lost in the determination is what is the condition of the patient at the time of choosing a hot or cold modality. Because one broke an ankle, tore a ligament, or suffered an injury months ago does not mean the condition is “chronic” since it happened months ago. Often the process of healing makes many situations “acute” to the moment.

Let’s examine whether to use hot or cold, but more importantly, why to use the hot or cold therapy.

Generally speaking immediately following acute injury the body goes into what is called an “inflammatory response” and the area gets red, gets hot and swells. During this time you don’t want to inflame an inflammatory reaction and make it worse so the general rule is use cold therapy (cryotherapy). The cold actually:

reduces the edema,

lessens the pain,

cools the temperature of the injured area, and

stops the inflammatory response.

The inflammatory response is natural and helpful but it can cause more injury especially in cases such as spinal cord damage, or brain injury where the swelling causes additional injury to healthy tissues.

After the swelling has stopped, the pain subsided some, and the area cooled down, then warm, moist heat is indicated ( not dry heat ) and that occurs generally when a patient is trying to regain motion, function. As the patient tries to regain full range of motion pain inhibits it and it is now that heat helps:

reduce pain

increase blood flow for faster healing

helps extend range of motion when used complementary with exercise.

Now here’s the “sleight of hand” that is often confusing to injured patients. Each time a patient goes through an exercise routine then new/old tissues are actually re-injured. That in and of itself re-excites the body’s inflammatory response so in essence the patient now has a “new injury” brought on by the rehabilitation process. So immediately after exercising it’s best to use cold therapy, not warm moist, as the area being exercised is now in a new “acute” injury process. Hot & Cold therapy is an example of ” complementary ” medicine to improve patient outcomes.